Subcortical Vascular Lesions Predict Falls at 12 Months in Elderly Patients Discharged From a Rehabilitation Ward

Abstract 

Guerini F, Frisoni GB, Marrè A, Turco R, Bellelli G, Trabucchi M. Subcortical vascular lesions predict falls at 12 months in elderly patients discharged from a rehabilitation ward.

Objective

To test whether subcortical vascular lesions are associated with falls in elderly patients with gait disorder discharged from a rehabilitation ward.

Design

Secondary 12-month follow-up analysis of an observational survey focusing on the prevalence of subcortical vascular lesions in a population of elderly patients discharged from rehabilitation hospitals.

Setting

A rehabilitation and aged care unit.

Participants

Consecutively admitted elderly patients (N=214) with gait disorder.

Interventions

Not applicable.

Main Outcome Measures

On admission, all patients underwent comprehensive geriatric assessment including sociodemographics, cognitive and depressive symptoms, nutritional status, physical health, and functional status. Subcortical vascular lesions were assessed on computed tomography films with a validated rating scale. All patients received a standardized rehabilitative program. Twelve months after discharge, all patients were interviewed by telephone, mainly focusing on the occurrence of falls during the follow-up period. Potential predictors of falls were assessed in univariate and multivariate analyses.

Results

Univariate predictors of falls were age, sex, Mini-Mental State Examination, Barthel Index on admission, and subcortical vascular lesions. In multivariate analyses, subcortical vascular lesions were the only significant predictor of risk of falling; patients with moderate and severe subcortical vascular lesions scores had a greater risk of falling (odds ratio [OR]=3.0; 95% confidence interval [CI], 1.3–7.1; P=.012; OR=3.9; 95% CI, 1.6–9.2; P=.002, respectively) than those with no subcortical vascular lesions.

Conclusions

Subcortical vascular lesions are associated with falls at 12 months in elderly patients with gait disorder discharged from a rehabilitative ward. Future research is needed to confirm our results.

Key Words: Accidental falls, Elderly, Gait, Rehabilitation

List of Abbreviations: CI, confidence interval, CT, computed tomography, GDS, Geriatric Depression Scale, MMSE, Mini-Mental State Examination, MRI, magnetic resonance imaging, OR, odds ratio, RACU, rehabilitation and aged care unit